title: [Role of renal dysfunction and multifocal atherosclerosis in assessment of prognosis of patients presenting with ST-elevation acute coronary syndrome].
abstract: OBJECTIVE
  To assess incidence and severity of renal dysfunction as well as its prognostic value in patients with ST elevation myocardial infarction (STEMI) and multifocal atherosclerosis (MFA).
  
  
  METHODS
  We enrolled in this study 529 patients with STEMI in whom we estimated creatinine clearance rate (eGFR) and glomerular filtration rate (eCrCl) using Cockcroft-Gault equation and Modification of Diet in Renal Disease (MDRD) formula, respectively. Duplex ultrasonography of lower extremity and extracranial arteries was performed in 423 patients on day 5-10 of hospitalization. Signs of MFA were found in 95% of patients. Hospital mortality was 10.9%. One year survival of 397 patients was assessed by the telephone contacts. Thirty nine patients (9.8%) died.
  
  
  RESULTS
  GFR in 35.5% of patients was 30-60, and in 4.9% - less than 30 ml/min/1.73 m2. At the same time 29.5% of patients had CCr 30 - 60, and 3.0% - less than 30 ml/min. Progressive decreases of eCCr and eGFR were observed in patients with incipient MFA (stenosis <30%); relationship between MFA and eGRF was more close. Presence of renal dysfunction in patients with STEACS and MFA was associated elevation of both hospital and 1 year mortality.
  
  
  CONCLUSIONS
  Any manifestation of peripheral atherosclerosis and impairment of renal function should be considered as independent predictors of cardiovascular events in patients after STEMI.
authors.affiliation: Research Institute for Complex Issues of Cardiovascular Diseases of SB of the RAMS, Sosnovy boul. 6, 650002 Kemerovo, Russia.
authors.forename: O L
authors.initials: OL
authors.lastname: Barbarash
authors.forename: M V
authors.initials: MV
authors.lastname: Zykov
authors.forename: I S
authors.initials: IS
authors.lastname: Bykova
authors.forename: V V
authors.initials: VV
authors.lastname: Kashtalap
authors.forename: V N
authors.initials: VN
authors.lastname: Karetnikova
authors.forename: L S
authors.initials: LS
authors.lastname: Barbarash
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016019:Survival Analysis; D018615:Ultrasonography, Doppler, Color / Q000379:methods